Violence Continues To Injure And Kill Workers

Although workplace violence has fallen from the second leading cause of death in the workplace to fourth, it remains a major source of injuries and fatalities in the workplace.

A couple of good new studies on workplace violence have been issued recently with some interesting results that need to be considered as part of the debate about what the role of federal and state occupational health authorities should be in preventing these hazards.

But first a pop quiz to test your knowledge.

1. Who are the most common perpitrators of workplace violence?

a. Co-workers
b. Health care or residential patients
c. Criminals (e.g. robbers)
d. Spouses and former boyfriends

2. After suffering a workplace violence incident, most employers will

a. Implement or change their workplace violence policies.
b. Do nothing, hoping it was just a fluke that will never happen again.
c. Call OSHA
d. Punish the victim

3. Which Occupation suffered the most violent incidents (in Oregon)

a. Police and detectives
b. Guards
c. Nursing aides
d. Teachers (except postsecondary)

Answers

The Bureau of Labor Statistics recently released a survey of workplace violence, Survey of Workplace Violence Prevention, showing that the great majority of establishments that had experienced a workplace violence incident, did not change their workplace violence prevention policies, even though the incidents had a negative impact on their workforce. The BLS found that state governments reported higher percentages of all types of workplace violence than did local government or private industry. Only 5% of all business suffered a workplace violence incident in 2005, but almost half of large businesses (1,000 or more employees) suffered an incident.

Meanwhile an Oregon Department of Consumer and Business Services issued a study, Violence in the Workplace: Accepted Disabling Claims due to Assaults and Violent Acts, Oregon, 2001-2005 (authored by Confined Space frequent commenter Tasha Hodges) reports that the state has received and average of 268 Accepted Disabling Claims each year for the past five years, including five homicides, which accounted for 2.6 percent of all work-related fatalities in Oregon. 41% of compensable assault claims were health care or residential care patients, and like the BLS survey, Oregon found that government employees suffer more workplace violence related injuries than private sector workers. The service and retail sectors were also heavily affected:

For most industries, assault claims accounted for less than 1 percent of all accepted disabling claims, but they accounted for 2.2 percent of claims in the service industry and 4.5 percent of claims from government.

The retail trade industry reported the third highest number of assault claims from 2001 to 2005, although the 159 assaults accounted for less than 1 percent of all of the claims for that industry.

And why do state government employees experience more workplace violence? According to the BLS:

These workplaces reported much higher percentages of working directly with the public, having a mobile workplace, working with unstable or violent persons, working in high crime areas, guarding valuable goods or property, and working in community based settings than did private industry.

The BLS report divides workplace violence into four types:

• Criminal: Usually robbery, shoplifting, or trespassing
• Customer or Client: Customers, clients, patients, students or inmates who have a legitimate relationship with the employer or business, and is being provided services.
• Co-Workers: employees or past employees
• Domestic Violence: usually a boy/girlfriend or spouse who assaults the victim at work.

Using similar categories, the Oregon study came to some conclusions that may surprise many people:

Many people assume that workplace violence refers to assaults perpetrated by violent employees. However, Oregon workers’ compensation data (as well as national data from the Bureau of Labor Statistics) do not support this assertion. Co-workers and former employees only accounted for 10 percent of assault claims from 2001 to 2005. The majority of assaults were committed by health care and residential care patients, who were responsible for 41 percent of assault claims.

Criminal offenders were the second most common violent attackers, accounting for almost 21 percent of assault claims. The criminal offenders category combines three distinct groups: criminal suspects, robbers and shoplifters, and correctional inmates.

Nursing Aides in Oregon suffered the highest number of assaults, follwed by police, guards and teachers.

Despite the prevalence of workplace violence, the BLS found that over 70% of all establishments had no workplace violence policy.

CalOSHA Cites Psych Center For Violence

CalOSHA has taken action to workplace violence in a psychiatric health center in Richmond, CA. The agency has fined Contra Costa County $20,805 for failing to provide adequate security at the Richmond health center after removing a uniformed safety employee from the premises.

The county is objecting to the fine with the ridiculous excuse that "we can't turn the place into a fortress," according to Dr. Jeffry Smith, who oversees medical services at the clinic and the county hospital in Martinez.

Why is this "fortress" excuse so ridiculous? The article in the Contra Costa Times notes that patients frequently bring concealed weapons into the center, and it's next door to a judicial complex and is often used as a walk-through by people going from court to the parking lot. There was recently a shooting incident at the center's entrance, although the office was cited by CalOSHA before that.

So what does Johnson consider "fortress-like?" CalOSHA recommended metal detection equipment, security cameras, reception desk barriers, a panic button alarm system, and mandatory searches.

County officials say they haven't installed metal detectors because they want to "avoid treating patients like criminals." Hello people, been in an airport or federal or state government building recently. We're all treated like criminals. Welcome to America 2006.

County supervisors also removed public safety officers, or PSOs, from the Richmond center as well as health clinics in Pittsburg and Martinez earlier this year without first adequately assessing security needs, according to CalOSHA. The county claimed that it would rely on Richmond police, although CalOSHA accused the county of failing to get a realistic estimate of response times by Richmond police in one of the "most dangerous cities in California."

The infuriating thing about the county's response is that it's been over a decade since California -- followed by the federal government -- issued guidelines to prevent violence in social service and health care facilities. This should all be obvious stuff.

Kudos to CalOSHA for enforcing these guidelines. Unfortunately, there's been no such action by federal OSHA nor most other OSHA state plans.

Chronic Pain, A Hand Like A Claw, And The Lowest Injury & Illness Rates "On Record"

Secretary of Labor Elaine Chao is happy as a clam over a recent Bureau of Labor Statistics report that the rate of injuries and illnesses have gone down for the third straight year from to 4.8 cases per 100 workers in 2004 to 4.6 cases per 100 workers in 2005.

According to Chao, all credit goes to

1) compliance assistance; 2) health and safety partnerships with labor, and; 3) targeted, aggressive enforcement against bad actors. (emphasis added)

Now I can't quite tell whether she's joking, or suffering from the same delusional disease affecting the Pentagon, but "health and safety partnerships with labor?" Puleeeze!

Oh, and Elaine, you don't get a reduction in national injury and illnesses number by going after a few "bad actors." You also need to go after all the other "normal actors" who cut a few corners here, rush a few jobs there, and ignore ergonomics and chemical hazards. Oh, and if you really want to address a signficant number of workplace injuries and illnesses, you might want to depend a bit less on the "compliance assistance," and issue a few new standards that address issues like ergonomics and workplace violence which make up for hundreds of thousands of injuries every year.

If the numbers are accurate, this is good news. But, of course, all of this assumes that we even believe these numbers -- and with cases of employers being caught cheating, with "behavioral" incentive programs that discourage employees from reporting injuries and illnesses, one could be forgiven for being a tad bit skeptical.

But most important, these are only numbers, statistics, millions of them. And as famed occupational physician Irving Selikoff once said, “statistics are human beings with the tears wiped away.”

What tears are we talking about? Here's one tragic example, and this one didn't even make it into Chao's statistics:

He lost his apartment two years ago, after losing his job. He lost his job after falling off scaffolding in an unacknowledged industrial accident. The company lawyer does not answer his phone calls. Now he has chronic pain, a hand like a claw and a bed in the homeless shelter.

My patient likes to talk about the apartment he used to have, and the honest satisfactions of a home. He liked taking his shower after work, watching his TV. He had a girlfriend who tidied the place from time to time. He took the bus to and from work and said that whenever someone was missing bus fare, he would reach into a pocket and supply it. It felt good, like buying everyone a round. He was not a drinker, but altruism was something he enjoyed.

He especially liked his apartment key. But no job, no key. At first, he slept in a condemned building; it gave comfort, and the illusion of a home: there were doors to walk through. After the building was demolished, he came to the mental health clinic. He had all the profound symptoms of depression one would expect. He understood that antidepressants take weeks to work, and dutifully accepted that fact. He was willing to be patient.

He got thrown out of the shelter, and built himself a nice lean-to in the woods, "using tree stumps and branches, and his one good arm."

He says he lies in it and can see the stars in the roofless sky. There is no heat or electricity, of course, and the house is not structurally safe, but he doesn’t mind. He looks up, and hours pass. In the dark, lying on the floor looking up, he begins to feel the absence of grief, of anger. He feels the blessing of no feelings at all.

The medication is still not working. It won’t work, when his need is for a key. He has begun to talk about train tracks and the uselessness of life. He says one day he may not return to the clinic. He won’t tell me where his house in the woods is, though for now he continues to visit it. It offers respite from the anxiety, rage and heartbreak he faces in the shelter.

Feeling nothing, he says thoughtfully, is almost like feeling peace.

4.6 per 100. I feel much better now.

Social Worker Killed in Kentucky: Tax Cuts And "Small Government" To Blame?

This is chilling story of the price that our society pays -- or more specifically that workers pay -- for listening to Republican ideologues like Grover Norquist who delight in the prospect of "Shrinking government to the size where we can drown it in the bathtub." Unfotunately, workers are drowning in that bathtub as well.

A social worker who had taken a 10-month-old boy to his mother's house for a visit was found beaten and stabbed to death, and the baby was apparently abducted, authorities said.

Police found the body of Boni Frederick, 67, at the house on Monday after she failed to return to work. Her car was missing.

Police searched on Tuesday for the missing boy, who was believed to be with his mother, Renee Terrell, 33, and her boyfriend.

The child had been taken from his mother when he was 13 days old because of neglect, police said.

"It's a dangerous job anytime you're taking someone's child away from their parents," Sgt. Dwight Duncan said. "You know how protective parents can be."

When people think about workplace violence, the automatically think of insane postal workers gunning down their co-workers and supervisors. But it was the Boni Fredericks of the world that haunted me throughout my years at AFSCME. The social workers, child support workers and others who had the difficult, unpleasant and dangerous job of enforcing our child protection laws against angry, and often mentally ill family members. They often had to venture into peoples' homes alone, into neighborhoods that even the police feared to enter with guns drawn. And all too often, they paid the ultimate price for doing society's dirty work.

Earlier this year, Sally Blackwell, a program director with Texas Child Protective Services, was found dead in a field. At the time, authorities would not say whether her death was related to her job, although she had received threats. In 2005, Marty Smith, a Washington State crisis responder for the state mental-health system, was killed checking on a schizophenic client whose mother had called to say he wasn't taking his medications.

Threats and violence against social service workers is nothing new, but it rarely rises into the headlines until someone gets killed. A recent study conducted by the National Association of Social Workers found that 55 percent of 5,000 licensed social workers surveyed said they faced safety issues on the job. Sixty-eight percent of them said their employers had not adequately addressed their concerns. A survey in 2002 of 800 workers found 19 percent had been victims of violence and 63 percent had been threatened.

In 1997, federal OSHA issued Guidelines for Preventing Workplace Violence for Health Care Social Service Workers to assist health care and social service workers to prevent workplace violence. The guidelines established workplace violence as a legitimate hazard that employers had a responsibility to prevent, and provided specific examples of how to prevent such assaults -- like not working alone, better communication, background checks, etc -- but OSHA refuses to enforce its own recommendations.

And it's not like we haven't been warned. Kentucky social workers have been concerned for some time about their safety:

Social workers and other say Frederick’s death underscores the danger of the job where workers often are confronted by violent and angry adults as they seek to protect children.

“We knew it was only a matter of time,” Patricia Pregliasco, a social worker with the state Cabinet for Health and Family Services, said Tuesday. “We hoped and prayed this wasn’t going to happen.”

Social workers for the past year have been increasingly vocal about their growing caseloads and lack of adequate resources to do their jobs.

State officials are reorganizing the child welfare system to try to help but said they have no additional money for more workers and support staff.

“We’re concerned about our safety,” said Tricia Mack, also a social worker in Jefferson County. “We go out and there’s a lot of times clients make threats.”

Mack and Pregliasco said social workers often go alone to homes.

Family Court judges say their caseload of abused and neglected children is growing and the child welfare system simply doesn’t have resources to meet the needs.

“We’re hemorrhaging cases,’’ said Jefferson Family Court Judge Patricia Walker FitzGerald.

Dr. James J. Clark, a social work professor at the University of Kentucky, said that Kentucky – like most states – doesn’t have sufficient resources to handle the increasingly complex cases of child abuse and neglect.

“I think it’s pretty clear that child welfare is pretty under resourced everywhere in the United States,’’ he said. “It’s just not a priority area for a lot of state governments.”

As I wrote following the death of a California mental health worker in 2003, we need to look at the real root causes of these tragedies. When voters, whipped into an anti-tax frenzy by right-wing radio talk/T.V. show wingnuts, as well as politicians seeking to ride the their wave, refuse to see the need to maintain -- or even expand-- government revenues to pay for needed government services, you end up with more needy people getting fewer services from social service workers who don't have the support they need to provide people with the help they deserve, and don't even have the support they need to provide for their own safety.

The result of this breakdown in our ability to treat those who suffer from mental illness is not just a tragedy for them and their families, but for our society as well -- particularly for those members of our society who take on this nation's toughest and most dangerous jobs of providing us with security and providing assistance for people most in need of help -- in a system that refuses to provide the support that they need.

This collective unwillingness to pay for the social services that the people of this country need has ramifications throughout society -- especially for abused children, mental health patients and their families -- and especially for those members of our society who take on this nation's toughest and most dangerous jobs of providing assistance for people most in need of help. The question isn't whether or not we should have higher or lower taxes, or whether we need a big or small government, but who will pay for the things that society demands to make life in this country civilized and livable? We can hide our heads in the sand, but in the meantime, workers like Sally Blackwell, Marty Smith, Boni Frederick have paid for ideological fraud and society's blindness with their lives.

They deserved better.


Related Stories

• A Broken Mental Health System; A Dead Police Detective, May 6, 2006
• Case Worker's Death Spurs Safety Campaign in Washington, January 29, 2006
• Conducting The Public's Business -- And Dying For It, November 11, 2005
• Precautions Save the Life of Child Protective Services Worker, February 17, 2005
• Social Worker Killed In The Line Of Duty -- What's Being Done?, September 14, 2004
• Workplace Violence in Health Care on the Rise, April 26, 2004
• Workplace Violence: Fashionable vs. Unfashionable, January 18, 2004
• Who really killed Dr. Erlinda Ursua? December 2, 2003
  

Homicide: Leading Cause Of Workplace Death For Immigrants

Take a walk or ride through any big city in the United States and you'll find that most of the workers in the small retail food and convenience stores, and most taxi drivers are immigrants. That's where they work when they first come to this country, and increasingly, that's where they die.

Chicago Tribune reporters Stephen Franklin and Darnell Little have written another excellent article in their series on Throwaway Lives about immigrants in the United States. This one is about workplace homicide, the leading cause of death for foreign born workers. Take a look at any Weekly Toll, the Confined Space list of workplace death. There are always a shockingly high number of retail store homicides, usually of immigrant workers.

It's tragic, and, contrary to what many people think, it's preventable:

A Tribune analysis shows that in 2005, when foreign-born workers made up 15 percent of the nation's workforce, 188 were murdered on the job, accounting for more than a third of the 564 workplace homicides, the highest ratio since the government began keeping track in 1992.

Much of this loss of life can be avoided with measures that are both well-known and not costly, experts say. But protecting cab drivers and store clerks hasn't been as big a priority as saving lives on the factory floor, they add.

"This is a terrible thing and it is fixable," says Rosemary Sokas, a workplace safety expert at the University of Illinois at Chicago and a former official at the research arm of the U.S. Occupational Safety and Health Administration.

A $500 plastic shield that separates taxi drivers from passengers can save countless drivers' lives, say experts like Sokas.

Between 1992 and 2005, the latest year for which statistics are available, 3,040 foreign-born workers were murdered on the job, according to government figures. Most of the victims were Mexicans, but the workplace homicide rates were the highest among immigrants from India, Cuba, Korea and Vietnam.

In 1998, OSHA published guidelines for late night retail workers, that included such recommendations as physical barriers (such as bulletproof enclosures), pass-through windows in late night retail, or deep service counters, alarm systems and panic buttons, elevated vantage points, clear visibility of service and cash register areas, bright and effective lighting, adequate staffing, arranging furniture to prevent entrapment and cash-handling controls, such as using drop safes.

Unfortunately, OSHA does not cite employes for not following the guidelines. In fact, OSHA rarely even investigates workplace homicides, especially in retail establishments. Large corporate chains generally follow the guidance, but not other stores.

Dr. Linda Degutis, a professor of emergency medicine at Yale University, is
a leader of the American Public Health Association, which, along with other
safety groups, has urged the federal government to take steps to try to curtail
such violence.

They want OSHA to issue a regulation laying out basic protections for these workers. If the federal government won't, then they say cities and states should step in. So, too, businesses should shoulder some of the burden, safety groups say.

"There are ways we can at least make a start," says Degutis. "Maybe we can't decrease everything, but maybe we can decrease the toll."

But getting the federal government and states to act and businesses to comply has not been easy.

Amid opposition from the retail industry, which complained about the potential paperwork and governmental intrusion, OSHA in the 1990s mulled a proposed regulation that applied to late-night workers at retail stores and cabs. Finally, the regulatory agency came up with a voluntary guideline in 1998 for late-night stores.

Charles Jeffers (sic), OSHA's director from 1997 to 2000, recalled that he didn't think the agency would be able to police grocery stores and taxi stands to see if they adhered to the regulation. But he also felt the problem couldn't be ignored.

"When we first got into this, there was a great outcry from the industry that there was nothing we could do. I just don't think it is acceptable to say the employee shouldering the risk is enough," he says.

Three states, Washington, New Mexico and Florida have passed laws addressing violence in retail stores, but they face fierce industry resistance:

In two of the three states with regulations for retail stores, industry groups challenged the laws. They lost their challenges in Florida, and a court battle over a 2004 law in New Mexico is not yet resolved. Washington is the other state with a law meant to protect retail store workers.

The logic they use in opposing the laws is remarkable:

"If it [the law]were necessary, every state would have it," says Ruben Baca, of the New Mexico Petroleum Marketers Association, which is fighting the 2004 law. "There are violent people out there, and what they need to do is put violent people away."

Well, first, if it wasn't for all the opposition from associations like yours, every state probably would have such laws, or better yet, a national OSHA standard. Second, sure we should put the bad guys away, but in the meantime, should we also take all the locks off the doors?

Sheesh!

Meanwhile, for cab drivers, a fact sheet suggesting bullet proof shields and cameras was all that OSHA has issued addressing violence. Some cities have adopted those recommendations.

Since 1998, for example, Chicago's 13,000 drivers of company-owned cabs have been required to have shields.

Now Chicago officials are finalizing a regulation that would allow drivers to replace the bullet-resistant shields with cameras, a move that probably would be well-received by drivers who have complained about the shields.

"Drivers generally don't have the shield closed because the customers hate it," says Jack Nichols, a veteran manager at Flash Cab Co. But at classes for the drivers, which are mandatory, Nichols often skips talking about safety.

In addition to being the leading cause of death for foreign born workers, workplace homicide has continuously been the second or third leading cause of workplace death for all workers nationwide. There's a myth that nothing can be done about it, and there's an assumption that even if something can be done about it, it's either not OSHA's job or there's no way, given its current resources, that OSHA can do anything about it.

It's an assumption that we need to change. Good work was done on the issue in the 1990's, and regardless of resistance from the retail industry associations, it's work that needs to be done again if OSHA is going to be serious about its mission to make all workplaces safer, whether you're working on a drill press, digging trench, building a house -- or slinging hot dogs or driving a taxi.


Related Stories

Workplace Violence: What It Mostly Is, What It Mostly Isn't, June 26, 2006
Workplace Fatalities That OSHA Ignores, October 1, 2005
New Mexico Petroleum Marketers Seek To Overturn Workplace Violence Standard, August 16, 2005
New Mexico Issues Late Night Convenience Store Violence Standard, February 1, 2005
APHA Calls for OSHA Workplace Violence Standard, January 6, 2005
Cabdriver Shot. A "Freak" Thing?, November 29, 2004
What's Henshaw Got Against A Little Violence?, November 15, 2004
Immigrants & Teens: Frontline Soldiers in the War Against Retail Crime? July 28, 2004
Workplace Violence: Fashionable vs. Unfashionable, July 18, 2004
What OSHA Investigates: Not the two biggest killers of American Workers, April 15, 2004
Seattle Cab Drivers Stage Work Stoppage Over Safety, February 12, 2004
Minneapolis Cab Driver Action Update, August 19, 2003
Minneapolis Cab Company Agrees to Put Cameras in Cabs, August 13, 2003
Minneapolis Taxi drivers call for one-day walkout over health and safety conditions, August 11, 2003

Why Unions Are Good For Nurses -- And Your Health

Responding to the NLRB's Kentucky River decision that takes away bargaining rights for millions of American nurses and other workers, Sarah Solon at the DMI Blog explains why unions are good for nurses -- and women. And it goes far beyond just the wages and benefits that most people think of when they think of unions:

When I say "unions are good for nurses," here's what I mean: unionized nurses and charge nurses make around 13% more than non-unionized nurses, union contracts mandate safety in the workplace, union contracts mandate lower nurse-to-patient ratios which have been shown to greatly increase patient care, union contracts increase pay and increased pay has been shown to ameliorate the nursing crisis at certain hospitals that have raised their nursing compensation packages...the list goes on and on.

The kicker with union contracts and nurses is that 92.3% of nurses are women. Of these nurses, "72% of nurses don't feel safe from assault in their workplace, up to 95% of nurses reported having been bullied at work, and up to 75% of nurses reported having been subjected to sexual harassment at work." 35% of nurses who participated in a given study left their jobs because of verbal abuse from a physician - the primary cause of the bullying and harassment of nurses at work. And let's remember that nurses work in hospitals and other health-care facilities - where their patients long-term health, in not their life, is on the line. Given the huge importance of the tasks nurses must accomplish during their shifts, it's completely unacceptable that "at least 70 percent said blowups with physicians [the most common form of verbal abuse of nurses] increases errors, and nearly as many said it decreases productivity on the job."

The workplace horrors of harassment and bullying are far too prevalent among nurses, and union contracts include provisions for protection from these abuses, many of which are only exacerbated by gender issues. United American Nurses contracts, for example, "put nurses on safety and health committees and purchasing committees, giving nurses an equal say in safety policy and requiring hospitals to buy the safest products available. Contracts commit employers to measures that prevent violence and enforce zero-tolerance on hostile, abusive or disrespectful behavior - from anyone." And in one of their specific contracts, "Nurses at Fairview Hospitals in Minnesota ratified language requiring the hospitals to prevent violence and verbal abuse through patient risk assessments, an annual course on de-escalation, behavior management, physical protection and a trained response team."

Oh, and by the way, your life may depend on it. A recent study shows that 20,000 people die each year because they have checked into a hospital with overworked nurses and union contracts mandate lower patient-to-nurse ratios,

Florida Mental Health Workers Make Progress After Attendant's Death

Public employees do jobs that most of us don't even like to think about. For example, criminal defendants who are found incompetent to continue with court proceedings because of mental illness, retardation or autism, or who are acquitted of felony charges -- by reason of insanity? Where do they go? Who takes care of them? Who cares?

Well, in Florida, it's the attendants at the Florida State Hospital in Chattahoochee. What's it like to work there in modern times? You get spit on, beaten up regularly, sometimes killed, threatened with discipline if you complain and no one really appreciates the job you do or how dangerous it is. The only bright spot is that they have a union that's willing to fight for them.

Two weeks ago, I wrote about the death of Florida State Hospital mental health attendant, James Smith, who had a heart attack after coming to the aid of another attendant who was being attacked by a patient. The workers at the Florida State Hospital in Chattahoochee had complained about understaffing and frequent fights with patients who are criminal offenders sent to the hospital as mentally unfit for trial or for psychiatric evaluation. A recent state audit had confirmed understaffing and a sharp rise in violent assaults against staff.

Earlier this week, the workers and their union, the American Federation of State, County and Municipal Employees (AFSCME), met with state legislators to describe conditions in the hospital and how "they are frequently assaulted, spat upon and threatened by criminally insane patients." The workers blamed Smiths death on understaffing, although the hospital denied it.

Doris Cobb, the shift supervisor, disputed DCF claims that there were 18 employees on duty that evening -- well over the minimum staffing level of 12 for four hospital units. Cobb said Smith and Doug Harris, the injured coworker, were watching 25 patients and a third attendant was working in a "chart room" off of the hospital floor when the incident occurred.

For the hard and dangerous work they do, public employees in Florida are rewarded by having no right to a safe workplace. Like public employees in 24 other states, Florida public employees are not covered by OSHA. The state had a non-federally approved state law covering public employee health and safety until it was repealed in 2000.

It not only takes some courage to work in these dangerous facilities, but it also took some courage for the workers to testify before their lawmakers about their working conditions:

Several employees expressed fear of losing their jobs or being placed on undesirable work shifts for speaking out. Cobb and other workers and supervisors said, however, that Smith's death and many years of legislative inaction on hospital conditions left them no choice.

The Department of Children and Families denied that there would be any retaliation against staff members for publicly discussing working conditions at the meeting, which was organized by the American Federation of State, County and Municipal Employees.

In any case, the workers had finally had enough and were not about to be quiet about the people they are assigned to care for, and the lack of support they get:

'When they're in jail, they're 'inmates,' but when they come to us, they're 'residents,'" Cobb said, drawing loud applause and shouts of approval. "Then they go back to jail and they're 'inmates' again."

Joann Williams said she suffered a back injury when a patient attacked her.

"From the Department of Corrections or wherever they come from, those residents we get are still murderers," she said. "On the floor where I work, our minimum coverage is two . . . and we have no protection either."

Williams added, "We're trained to say, 'Excuse my touch,' and ask their permission to touch them - and I can only touch the resident in a way that they will not feel threatened."

Again, heads around her nodded.

***

Employee Verdell Sutton, who has almost 24 years' service, displayed a knee scarred by reconstructive surgery she underwent after intervening in one patient's attack on another.

"If they kill one of us, what happens? They're still 'residents,' " she said. "When we do our jobs, we have a right to be protected."

And they weren't alone. Program specialist Frankie Duncan

who marked her 27th anniversary at the hospital on Wednesday, grabbed the microphone for an informal straw poll.

"If you have either been assaulted or involved in a fight where you feared for your own safety and your life, would you please raise your hands?'' she said. Everyone in the room raised a hand as Duncan turned toward the lawmakers and said, "That ought to show you something because this is just a random sampling - it looks like this all over the hospital."

Meanwhile, the state announced that it is planning on adding more beds and staff to the unit, but instead of hiring permanent employees, they're contracting out the new positions to a private company. The privatized workers will have no no insurance, vacation, job security or other benefits -- and no union protection. At least the new workers won't be complaining much about conditions at the facility.

In addition to safer working conditions, the employees are also trying to get the same 3 percent special-risk retirement credit that Florida police, firefighter and corrections officers receive, so they can retire at a younger age without loss of benefits.

Florida state Senator Al Lawson and Representative Curtis Richardson, both Tallahassee Democrats, told workers at the overflow meeting that they "have assurances from the Department of Children and Families to extend "special risk" retirement benefits to the hospital attendants."

Department representatives confirmed that promise:

Children and Families Secretary Lucy Hadi said her department will support special-risk retirement credit for the unit treatment and rehabilitation employees and will ask the 2007 Legislature to improve minimum staffing levels at the hospital.

Sounds good. We'll be keeping an eye on them. And while they're at it, maybe they should make sure those staffing levels are real and filled with full time employees that have a stake in the system. Early retirement is good – if you live that long and you're health enough to enjoy retirement. Too bad it had to take the death of James Smith to get something done.

Mental Health Attendant Dies Of Heart Attack After Violent Incident

An attendant at a Florida mental health institution died of a heart attack yesterday after coming to the aid of another attendant who was being attacked by a patient.

James Smith, 52, of Gretna apparently suffered a heart attack, the state said Friday. He was a ''unit treatment and rehabilitation'' worker at Florida State Hospital in Chattahoochee for more than 32 years, the Department of Children and Families said.

The unit where the attack occurred is in a part of Florida State Hospital that treats criminal defendants who are found incompetent to continue with court proceedings because of mental illness, retardation or autism, or are acquitted of felony charges by reason of insanity.

Conditions at the unit are difficult and dangerous for its employees:

Employees in the maximum-security units at the hospital often have complained about unsafe working conditions and frequent fights with patients who are criminal offenders sent to the hospital as mentally unfit for trial or for psychiatric evaluation.

An inspector general investigation in July found that minimum staffing levels are sometimes not met at the hospital - from minutes to hours - as patients are escorted for treatment.

Jeanette Wynn, state president of the American Federation of State, County and Municipal Employees union, or AFSCME, said low-wage workers are threatened by understaffing.

The unit training and rehabilitation workers like Smith who interact with patients on a daily basis do not get the same ''special risk,'' retirement and wage benefits as the guards who patrol the hospital perimeter, or the nurses who care for patients, Wynn said.

"We've been trying to get them special risk for 10 years,'' said Wynn, who worked for years at FSH.

The report also said that

"between April 2004 and April 2006, Unit 23 had a 145-percent increase in aggressive behaviors, with Unit 24 at an 87-percent increase. The data indicated the overall increase in aggressive behaviors for both units was 116 percent." Despite "a significant increase in incidents over the past two years," the report said, "there has been no increase in staffing or minimum levels for many years."

Related Stories

• "Taking your life into your own hands just to get the job done:" Missouri Mental Health Institutions, June 22, 2006
• Case Worker's Death Spurs Safety Campaign in Washington, January 29, 2006
• APHA Calls for OSHA Workplace Violence Standard, January 6, 2005
• What's Henshaw Got Against A Little Violence?, November 15, 2004
• Workplace Violence: Fashionable vs. Unfashionable, January 18, 2004
• Who really killed Dr. Erlinda Ursua?, December 2, 2003

Right-Wing Threats Against Judges Finally Paying Off

And speaking of workplace violence and assaults against those who are defending our way of life, last year I wrote a post about Republican politicians promoting violence against judges because of their decision on Terry Schiavo and other decisions that right-wingers didn't like.

Remember Tom Delay (ex R-TX):

"Mrs. Schiavo's death is a moral poverty and a legal tragedy. This loss happened because our legal system did not protect the people who need protection most, and that will change. The time will come for the men responsible for this to answer for their behavior, but not today.

And also from Texas, we had Senator John Cornyn:

I don't know if there is a cause-and-effect connection but we have seen some recent episodes of courthouse violence in this country. Certainly nothing new, but we seem to have run through a spate of courthouse violence recently that's been on the news. And I wonder whether there may be some connection between the perception in some quarters on some occasions where judges are making political decisions yet are unaccountable to the public, that it builds up and builds up and builds up to the point where some people engage in -- engage in violence.

I wonder.

Well, it seems that their wishes may finally be coming true:

Threats against federal judges are on a record-setting pace this year, nearly 18 months after the family of a federal judge was killed in Chicago.

U.S. Marshals, who protect the nation's 2,200 federal judges, believe they averted another potential tragedy in the Midwest last year when they helped block the release of a prison inmate who told a judge in a series of sexually charged letters that he was going to take her away.

Threats and inappropriate communications have quadrupled over 10 years ago. There were 201 reported such incidents in the 1996 government spending year and 943 in the year that ended Sept. 30, the Marshals Service said.

This year alone, the Marshals Service has had 822 reports of inappropriate communications and threats, a pace that would top 1,000 for the year.

Why fight terrorism abroad, when there's so much to do here.

Via Attywood.

Maryland Prison in "Full Crisis" Following Killing Of Officer

One area of occupational safety that we don't cover much here are the work hazards experienced by correctional officers, or as some know them, prison guards.

The hazards of that job hit the headlines in the Baltimore/Washington DC area last week with the murder of a correctional officer at the House of Correction in Jessup, Maryland. It was the second correctional officer killed on the job in Maryland over the past year.

David McGuinn, 42, was counting inmates alone in the maximum-security prison late Tuesday when he was attacked and stabbed several times in the neck and back, said Maj. Priscilla Doggett, a spokeswoman for the Maryland Division of Correction.

***

The Maryland House of Correction, built in 1878, has been wracked by violence in recent months. Three inmates have been killed there since May, and inmates assaulted two officers in April. Doggett said officials don't believe the assaults were related, but they are investigating that possibility.

While at AFSCME, I had to investigate several incidents that occurred in prisons. And whether you're touring the cell blocks, or attending a meeting in the building, they're creepy places. But despite the fact that your job is to oversee dangerous prisoners, the hazards of correctional institutions are no different than other workplace hazards: they're well known and their are well-recognized systems that can be put in place to minimize or eliminate them. In other words, as with most workplace safety and health problems, injuries and fatalities in correctional institutions are laregely preventable if management is doing what needs to be done.

Understaffing, unreliable equipment and poor leadership are among the problems contributing to deteriorating working conditions at the prisons, union representatives claimed.

"When you have more inmates, more dangerous inmates, it's the wrong time to cut the number of security employees, which this administration has done," said Sue Esty, legislative director of American Federation of State, County and Municipal Employees Council 92.

For Maryland Correctional Institution officer Kenny Neely, conditions in the prisons have made going to work miserable.

"It used to be something I was proud of. I'm not anymore. It's just a job," Neely said. Because the prison is short-staffed, Neely said he typically works 48 hours a week, including shifts on Friday, the first day of his weekend.

According to witnesses,

The inmates escaped from their cells despite a prisonwide lockdown, apparently by jamming the locks on their cell doors, and then returned to their cells after the attack, authorities have said. According to the documents, "a device commonly used by inmates to prevent their cell doors from locking" was found on the ground outside Harris's cell.

Ron Bailey, executive director of the American Federation of State, County and Municipal Employees union, which represents corrections officers, confirmed yesterday that inmates at that facility and others "come up with all types of homemade devices" to jam locks. Decks of cards, tape and hard plastic objects of many kinds can be put to that use, Bailey said.

McGuinn, 42, was the second Maryland and the first to be killed inside a prison since 1984.

McGuinn was the second Maryland corrections officer to be killed this year. Roxbury Correctional Institution officer Jeffery A. Wroten was shot in the face with his own gun while guarding a prisoner as he underwent treatment at Washington County Hospital January 27.

Before this year, the last killing in the Maryland correction system occurred in 1984.

Union officials said that doesn't mean guards haven't been attacked in the past 22 years. Just a couple weeks ago, a guard was stabbed in the arm while trying to subdue an inmate in his cell.

Bernard W. Ralph Jr., president of the local AFSCME union, said officers always getting punched in the mouth and thrown down steps.

"You don't hear about that, but it happens everyday," Mr. Ralph said.

The Baltimore Sun is calling for the state to shut down the ancient prision, calling the situation a "full crisis."

When three inmates at the state's maximum-security House of Correction manage to foil a prison lockdown to murder a correctional officer, the Jessup prison has gone beyond troubled. It's in full crisis.

Officer David McGuinn was killed hours after state prison officials announced the appointment of a new warden at "The Cut," the prison's nickname. But changing a warden won't secure this prison. It's understaffed and ill-suited to an increasingly violent population; without a major state commitment, the warden won't be able to reform the prison culture there.

Officer McGuinn, 41, wasn't stabbed to death while breaking up a fight or subduing a fleeing felon. His murder was a targeted assassination. What's worse, shockingly so, is that prison officials had been warned of a possible attack on an officer. And still prisoners pulled it off.

***

Those are short-term fixes. The House of Correction, which dates to 1878, doesn't meet the housing needs of its hard-core inmates and offers no programming to constructively address their lengthy stays, which average about 10 years.

The state can't delay demolishing the prison any longer - it has been talked about for years - because it takes five years to build a maximum-security prison. Until then, prison officials should reduce the inmate-to-prison-guard ratio at the House of Correction and give priority to restoring its full complement of guards. But in a corrections system that is down 500 guards, securing one prison may come at the cost of another.

The officer's union, AFSCME, requested a meeting with Maryland Governor Robert Ehrlich to discuss conditions in the prisons system. Ehrlich, a Republican, refused to meet with the union because he wanted to focus to remain on the family:

“The death of Officer McGuinn is a tragedy, and my heartfelt prayers go out to his family,” Ehrlich said in a statement. “His death is a reminder to us all of the danger that law enforcement professionals like Officer McGuinn face every day.”

In other words, prisoners are bad people, prisons are dangerous, what do you expect, let's move along:

Prison spokeswoman Maj. Priscilla Doggett said she “didn’t know why” the prison had seen such intense violence recently.

“We realize we’re trying to manage a population that is violent and given to committing acts of violence,” she said.

Yeah, shit happens.

Addendum

One other point I forgot to make yesterday: You'll notice the complete absecne of any mention of OSHA in the coverage of this incident. Why? Aren't corrections officers workers? Aren't there plenty of policies and guidelines (even if no speicific OSHA standards) that describe measures that can be taken to prevent these incidents (e.g. staffing, working alone, etc?) Despite OSHA's forays into the area of workplace violence in the 1990's, they have been extemely reluctant to get involved in prison issues (unless officers are being exposed to chemicals from prison factories, or bloodborne pathogens.) When it comes to staffing, or dealing with "bad guys," as opposed to bad chemicals or bad germs, OSHA generally leaves the solutions and sanctions to the employers (prison officials) and state corrections officials, a practice that would not be tolerated when it comes to more common workplace hazards like machine guarding or exposure to chemicals.

Workplace Violence: What It Mostly Is, What It Mostly Isn't

About once a year, I need to go through the tedious process of straightening the world out about workplace violence. The current round was stimulated by this article, "Workplace violence can be predicted, experts say." The article goes on to note that "Nationally, more than 20,000 incidents of workplace violence are reported each year, ranging from verbal threats and unwanted sexual advances to pinching and pummeling."

But then it starts going off the deep end. After informing us that

the Bureau of Labor Statistics show that workplace violence is most likely to occur on Mondays, from 8 a.m. until noon. And violent employees are most frequently men aged 35 to 44 who have been with their employer for one to five years,

the article then drags out its main example to illustrate that workplace violence can be prevented: Edgewater Technology Inc. in Wakefield, Mass., where a 42-year-old computer software tester shot and killed seven coworkers in 2000. According to the facility manager, in retrospect, there were numerous warning signs of a "troubled employee," including mood swings, changes in appearance, a messy divorce, a previous workers comp complaint for stress, fascination with weapons and explosives and a diagnosis of schizophernia.

Luckily, in these post 9/11 days, there's solutions at hand:

Matthew Cabral, an inspector for the federal protective service for the Department of Homeland Security, said that since the terrorist attacks of Sept. 11, 2001, companies and government offices have increased security with metal detectors, bulletproof glass and concrete barriers that appear decorative, such as flowerpots, to prevent people from driving into buildings.

Now, all of this is well and fine. It's possible that if the employer were more attuned to this man's problems, and if they had a decent Employee Assistance Program, the incident might have been prevented.

But this whole anecdote misses the point about the problem of workplace violence in this country. Less than ten percent of workplace homicides result from what's known as "worker-on-worker" violence -- where a current or former employees comes into the workplace and shoots or stabs former co-workers or supervisors.

The vast majority of workplace violence consists of retail workers being attacked during robberies, taxi drivers being robbed, health care and social service workers being attacked by patients and clients, and security personnel (law enforcement or private security guards) being attacked by violent individuals.

Just as an example, take a look at the list below, most of which was pulled from the latest "Weekly Toll," a list of workers killed on the job over the past two weeks. Only one of these can be considered "worker-on-worker" violence.

ATTACKS ON FOREST SERVICE STAFF UP FIVEFOLD IN 2005
Builder security worker slain
Family Hopes $10K Reward Will Lead To Slain Worker's Killers
5 arrested in county worker's death
US agent among two dead in Florida prison gunfight
Cab Driver Found Dead In North Miami Beach Taxi
Hack's rare night shift proved deadly
Restaurant manager fatally shot in robbery
Pawn shop owner killed in Easley
Tattoo shop owner found dead
Liquor store clerk shot dead
Taxi Driver Found Dead Next To Cab
Gunman kills owner of store: This is fourth time in seven weeks a clerk in Modesto has been shot
Officer, Suspect Killed in Texas Standoff
Cordele store manager fatally stabbed
Security guard shot, killed near Victorville nightclub
Co-worker charged in fatal shooting
Pizza deliveryman, robbed and shot, dies of injuries
Video poker worker murdered
2 charged in slaying of parking attendant
Arrest made in death of liquor store owner

The premise of the article, however, is true: most of these incidents can be prevented. There are definite risk factors in retail establishments that can be addressed:

• Working with money.
• Working alone
• Working late nights
• Working in dangerous neighborhoods

In fact, in the late 1990's, OSHA published to workplace violence guidelines for health care workers and for late night retail workers, in addition to numerous fact sheets, and cites tons of literature describing steps employers can take to prevent workplace assaults. In addition, the state of New Mexico has issued a late night convenience store violence standard that requires convenience stores open between the hours of 11 p.m. and 5 a.m. either to have two workers on duty, or one clerk and a security guard, or to install bulletproof glass or other safety features to limit access to store employees. The state of Washington enforces a "Late Night Retail Workers Crime Protection Act" which requires annual crime prevention training, drop-safes or limited access safes, and outside lighting.

Numerous labor unions and the American Public Health Association have called on OSHA to issue a workplace violence standard. Meanwhile, responding to the high level of threats and assaults against public employees, New YorkGovernor George Patacki signed a bill earlier this month calling for managers of government worksites where at least 20 permanent full-time employees work to assess the sites' potential for violence. That bill and two others have been a major focus of public employee union organizing.

The good news is that workplace homicides have been declining over the past few years, from 1080 in 1994 to 551 this year, according to the Bureau of Labor Statistics. The bad news is that workplace homicides generally track the overall crime rate, which rose sharply last year after a downward trend over the past decade. Judging from the number of homicides in the average Weekly Toll, the workplace number may be rising again too.

The problem with articles like this is that they take the attention away from where the problem really lies. But, as I've written before, it's much more tempting to focus on the mentally unstable worker -- often postal workers -- who would come into work armed to the teeth and blow away their bosses and a few co-workers for good measure. These were fashionable because, unlike the unfashionable crowed, they got lots of press and provided fodder for armies of consultants who would scare employers into paying large sums for how to screen job applicants (or current employees) who might turn violent.

The bottom line is that any workplace violence policy should focus on the real risks of violence. While employers should be trained to deal with potentially unstable workers, it does little good to start profiling workers in a futile attempt to predict when one may go over the edge, while in the real workplace, workers are actually getting attacked by criminals and clients.

Related Stories

• "Taking your life into your own hands just to get the job done:" Missouri Mental Health Institutions, June 22, 2006
• A Broken Mental Health System; A Dead Police Detective, May 12, 2006
• Workplace Fatalities That OSHA Ignores, October 1, 2005
• Workplace Shootings: Crazy Workers or Crazy Workplaces?, May 29, 2005
• APHA Calls for OSHA Workplace Violence Standard, January 6, 2005
• What's Henshaw Got Against A Little Violence?, November 15, 2004
• Workplace Violence: Fashionable vs. Unfashionable, January 18, 2004
• Who really killed Dr. Erlinda Ursua?, December 2, 2003

"Taking your life into your own hands just to get the job done:" Missouri Mental Health Institutions

During my 16 years running the health and safety program for the American Federation of State County and Municipal Employees, I spent a lot of time out in the field, providing training for our members and listening to what their lives were like from 9 to 5 (or 5 to 1, or 1 to 9) while they worked.

A lot of those jobs I'd never want to do -- even if they paid decently, which most of them didn't. Close to the top of that list was mental health workers. I had enormous admiration for the caring people who did those jobs, and little understanding at first for how they could tolerate the working conditions, the chronic understaffing and constant threat of assault day after day. The answer was that they cared about people -- and they needed a job. The union, and the control that gave them over some of their working conditions -- even if limited -- was what made it tolerable to many.

The St. Louis Post Dispatch ran a series last week about horrendous conditions in Missouri's public and private mental health institutions. In summary,

Mentally retarded and mentally ill people in Missouri have been sexually assaulted, beaten, injured and left to die by abusive and neglectful caregivers in a system that for years has failed at every level to safeguard them.

While recent publicity over two of those deaths has sparked outrage across the state, a Post-Dispatch investigation has uncovered widespread mistreatment in 19 large state institutions and hundreds of smaller group homes supervised by the state across Missouri.

The abuse has been largely shielded from the public by broad secrecy laws, shoddy investigations and ambivalent police and prosecutors, and it has been perpetuated behind a series of broken promises by state officials to do better.

The abuse and neglect can be measured in numbers: 2,287 confirmed cases of abuse and neglect of residents since 2000. Of those, 665 resulted in injuries with 21 deaths.

And it is reflected in the skepticism of advocates, families, auditors and some caregivers themselves, who suspect that much more abuse and neglect has never surfaced in reports, lawsuits or the state database set up to track trends.

The series is chilling. Read it all if you have the stomach.

There is one part that is mandatory reading. Although the focus of the series is the "abusive and neglectful caregivers" as well as the criminally ineffective state oversight, the authors -- Carolyn Tuft and Joe Mahr -- also take the time to discuss the hazardous conditions, low pay and lack of support that the caregivers work under, and how those conditions contribute to the abuse.

They also acknowledge that they're not trying to accuse all workers of abuse.

Across the state, there are thousands of workers who provide quality care to mentally retarded and mentally ill residents. Parents offer story after story of caregivers who go beyond the job requirements, holding birthday parties or taking residents on shopping trips or out to eat.

But state officials and private facility operators acknowledge that the poor working conditions make it easier for bad workers - and some good ones - to mistreat the people they're supposed to be protecting.

The Mental Health Commission, which oversees Mental Health's management, noted in a joint statement this month that it's "abundantly clear" that workers "desperately need higher levels of support, leadership, and continuing education in order to function in their vital role.

First, there's the lack of training and support:

Once hired, new employees get two weeks of training and then spend a week watching other aides do their jobs. The training includes 16 hours learning how to manage aggressive residents and four hours on how to prevent neglect and abuse.

The private sector has fewer training requirements. Caregivers who work in both public and private facilities say the training is less extensive in private homes, particularly specialized care for some of the most challenging residents.

They receive training in abuse and neglect, emergency drills, and how to speak to residents and their families. They also must be certified in CPR.

But sometimes they don't keep current with their certification - a problem cited in a death in a Kansas City group home in 2001.

Then there's the pay:

Caregivers are paid about $9 an hour - making it hard to keep, recruit and train workers on how to handle challenging situations that can quickly evolve into abuse or neglect.

***

State officials, advocates and researchers acknowledge one of the best ways to make the job seem more like a career is simple: Pay more.

The average pay is $19,000 a year. And that's for a worker in a state facility. Those in private facilities commonly make less money, with fewer health benefits.

"We expect them to do it for a pittance of pay," said Bill Edmonds, the retired superintendent of a state-run facility in Nevada, Mo. "I had people working for me on food stamps, and that's a shame that people doing that kind of work have to rely on public assistance."

A 2004 study by The Associated Press found the Department of Mental Health had the highest number of workers who qualified for welfare benefits of any state agency in Missouri.

The lower pay makes it harder to hire people, said Felix Vincenz, who in February was named the head of all 19 state-run facilities.

"I think too often we've been in the mode of 'Let's take whoever comes across' because it's so challenging to get folks on board on some of these low-level positions," Vincenz told the commission this spring.

Some caregivers must work other full-time jobs to make ends meet. And then there's the forced overtime in state centers, some of which are so short-staffed they require workers to do two double-shifts a week.

Joe Lawrence, spokesman for the state workers' union, the American Federation of State, County and Municipal Employees, blamed state officials.

"When you have the worst-in-the-nation state-employee pay, on top of chronic understaffing and chronic overtime, they are fueling the turnover," Lawrence said. "This will leave staff vulnerable."

Researchers say low pay is a problem across the country. In Missouri, there's little debate from Department of Mental Health officials, who say they wish they could pay more.

In four years, the department's General Revenue funding was sliced by a tenth - resulting in cuts to the state workforce of 16 percent. This year, the Legislature gave back nearly all of the shortfall.

The new money will pay for more workers and a 4 percent raise for state workers - about $760 a year more for the average worker. The Legislature also approved a 7 percent boost in the amount paid to private facilities for each resident, but it is up to the providers how much of that will go to workers.

Then there's the violence and injuries suffered by the workers:

Police reports and state records show they have been hit, slapped, punched and stomped on by the patients they care for.

They've suffered black eyes, shattered teeth and broken noses, ribs, jaws, shoulders, cheeks and eye sockets.

Prisons may look more dangerous with their razor wire and high security but state workers compensation data shows that it's far more dangerous to work in a state facility caring for mentally retarded or mentally ill residents.

Workers who care directly for mentally retarded residents are four times as likely to be hurt by a resident as a prison guard is to be hurt by an inmate, according to a Post-Dispatch analysis of state injury data.

For workers who care for the mentally ill, the rate is nearly three times as high, the analysis showed.

At least 135 times since 2000, workers have filed police reports, complaining about such things as residents pummeling them, choking them unconscious and throwing urine on them.

State data shows the most abuse of workers occurs in the psychiatric hospital in Fulton, which houses some of the state's most dangerous mentally ill criminals.

In the state's 2004 fiscal year, Fulton workers suffered 331 injuries at the hands of patients. That is more injuries than prison guards suffered that year at the hands of inmates in the entire state correctional system.

State workers and officials offer a slew of reasons for the violence against workers across the system - chronically short-staffed facilities, frustrated patients who lack the mental capacity to control their anger, and caregivers who lack the proper training to calm those patients.

Department of Mental Health Director Dorn Schuffman said that prison guards must only ensure inmates don't escape or hurt each other, and they often do it from behind protective barriers. Mental health workers must be "therapeutically engaged" with residents, and deal much more passively with residents who turn violent.

Last year, the state began a pilot program at Fulton to teach workers safer ways to restrain violent residents. They hope to get federal money to expand it to workers across the state.

"A lot of these situations occur where our staff doesn't feel safe and may adapt ways (to cope) that are inappropriate," Vincenz told the commission.

In the meantime, the level of violence has spread fear among some workers. That's particularly true at Fulton, said Kevin Morris, who has repaired equipment there for eight years.

Each morning Morris drives into the center parking lot and walks through electronic gates that clank shut behind him. Once inside, he said, there is no protection from violent patients. This spring, he watched a patient grab an aide by the neck and beat him so hard the aide's glasses flew off and his ear began to bleed.

"You are really taking your life into your own hands just to get the job done," Morris said. "You have to always be looking behind you. It's not a pleasant place."

Recent research suggests the violence may have a chilling side effect: Fueling abuse and neglect of patients throughout the system.

One thing the authors fail to mention is Missouri is one of 26 states where public employees have no OSHA coverage. Although federal OSHA has not been particularly aggressive in enforcing safe working conditions in mental health institutions, the agency did issue guidelines for preventing violence for health care and social service workers. Although federal OSHA has not cited companies for workplace violence hazards in this administration, some states with OSHA state plans, such as California and New York, have been more active.

Missouri, until recently, was one of the many states in the country without laws allowing collective bargaining for public employees. Missouri workers finally won that right in 2001, only to have it taken away last year by newly elected Governor Matt Blunt.

Finally, it's reassuring to see that some of the many letters to the paper recognized the conditions under which the employees work.

This, from a nursing home worker:

Now, I don’t believe for a moment that all personnel at either nursing homes or homes for the mentally handicapped are at fault. Some of these people–at near minimum wage–bust their fannies to do what they can for their clients. But unfortunately even the best of them can be overwhelmed. If you’re assigned to care for 20 clients when reality dictates that you can only realistically care for 8, obviously the care you are able to give suffers. I think that many of the conciencious employees end up quitting because they can’t stand what they see day to day and feel they are letting their charges down. When they leave, that opens the door to the lazy, inept, and abusive. They’re the only ones who stay because they don’t care about their charges and really don’t have to in order to keep their jobs. I don’t know what the answers are, but increasing staff rather than decreasing it to save a few bucks would be a good place to start.

And this follow-up:

I agree - in addition to increasing staff, increasing education for the staff that need it should be addressed. There are amazing workers in these facilities that would die before they’d allow any sort of abuse to happen to their clients. Unfortunately as you stated, homes are drastically under-staffed. You have made so many good points. Direct care is HARD work. I couldn’t handle it when I did it. Great post.

Pataki Signs Public Employee Workplace Violence Bill

In a major victory for New York public employees -- and for the organizing efforts of New York's public empoyee unions -- Governor George Pataki has signed a bill calling for managers of government worksites where at least 20 permanent full-time employees work to assess the sites' potential for violence.

Passage of the bill was the result of a major organizing campaign by the New York Public Employees Federation and the Civil Service Employees Association (ASFCME Local 1000).

New York State Public Employees Federation (PEF) President Roger E. Benson applauded the signing of PEF’s Workplace Violence Prevention bill by Governor George E. Pataki. “The governor has led the fight to reduce violence and crime in our communities,” said Benson. “By signing the Workplace Violence Prevention bill, he is extending that effort to public-sector work sites.”

***

PEF mounted an aggressive Stop Workplace Violence Campaign earlier this year urging the passage of three bills including the Workplace Violence Prevention bill. PEF will continue to push the two remaining bills; The Judi Scanlon bill (S.207 Maziarz/A.2570 Hoyt) directs that an Office of Mental Health employee who is required to enter the residence of a person with serious mental illness can request to be accompanied by another employee for safety reasons. The Workplace Injury Disclosure and Accountability bill, (S.6480 Robach/A.9692 John) amends the Civil Service Law to require that the state Department of Civil Service prepare an annual report about injury rates among state employees due to workplace injuries in state agencies and the costs incurred by the state as a result of those injuries.

CSEA President Danny Donohue was also pleased with the Governor's action:

"CSEA believes this legislation is a common sense approach to a challenging situation and Governor Pataki has demonstrated good sense by signing it into law," said CSEA President Danny Donohue. "Assessing and reducing risks in public work sites will not only benefit the people who work in those locations, it will benefit all the people of New York in many ways. The governor's approval will also make New York the national leader in this area as we should be."

Donohue stated that the public will be safer when they use public facilities. He also pointed out that reducing injuries and the potential violence will save taxpayers money and improve morale and productivity in the public work force. CSEA has mounted a statewide media campaign in support of the measure in recent months and worked vigorously with its union activists at the grassroots level across the state to make the legislation a reality.

In addition to the legislative activity, CSEA and PEF are running major campaigns to help their members prevent assaults in the workplace. CSEA is conducting training and doing workplace assessments. PEF's Stop Workplace Violence campaign involves:

1. Ten day-long mobilization trainings around the state where workers develop workplace violence prevention "action plans" to implement in their workplaces
2. Collaborations with district attorneys as part of an effort to eliminate the double standard whereby crime in the street is prosecuted vigorously but crime in the workplace is felt to be "part of the job"

Both unions have suffered high numbers of assaults and murders of its members who work in social services and mental health.

Related Articles:

• Yellow signs and red tape : New York's Workplace Violence Prevention Program? May 11, 2006
• Workplace Violence in Health Care on the Rise, April 26, 2004
• NY Councilman, Workplace Violence Foe Shot Introducing Workplace Violence Resolution, July 25, 2003
• NY Public Employees Call for Workplace Violence Standard, July 22, 2003

A Broken Mental Health System; A Dead Police Detective

The Washington DC area was rocked earlier this week by the murder of detective Vicky O. Armel and critical wounding of another officer by Michael W. Kennedy, a mentally ill youth who opened fire armed with an an assault weapon, a hunting rifle and five handguns in the parking lot of the Sully District police station in Chantilly, Virginia.

But there was more behind this tragedy than appears at first glance. Armel wasn't just the victim of a random act of violence. Kennedy may have pulled the trigger, but the real root cause of this tragedy is this society's failure to address the problems of the mentally ill in this country.

During the late 1970's and 1980's, partly as a reaction to the warehousing of the mentally ill in large public institutions, and partly as a result of the newly popular ideas of cutting taxes and limiting government, large mental health institutions were closed and all but the most severely ill people were "deinstitutionalized" -- moved to community treatment aned out-patient settings. Whatever therapeutic potential deinstitutionalization may have held was never realized, because budget cuts soon resulted in many of the mentally ill being left on the streets to be treated by underfunded, poorly staffed outpatient and community mental health service agencies. People that needed supervision to be kept on their medications and in therapy were lost to the streets, and eventually to the prisons.

My first experience with the deadly results of these changes was the brutal 1989 murder of Robin Panitch in southern California. Panitch, a social worker and AFSCME member, was stabbed 31 times by a mentally ill client. Panitch's murder eventually led to the issuance of workplace violence guidelines by CalOSHA, the first time that workplace violence was treated as an occupational hazard in this country. Among other things, the guidelines called for higher staffing levels, alarms and more security for workers who had to work with mentally ill persons.

Unfortunately, many of these lessons remained unlearned, resulting in the death of Dr. Erlinda Ursua who was beaten to death by a patient in a state mental health hospital in 2003. Ursua had been treating the patient alone in a closed room despite a recent history of violence at the hospital that included over 100 attacks on staff in the previous year. Calls for security guards to accompany doctors in interview of potentially violent patients had gone unanswered due to funding problems

But workplace violence guidelines and more security guards, however necessary, are really only bandaids on a bigger systemic problem. Writing in the Washington Post today, former Post reporter Pete Earley connects the dots, recounting his experience with Detective Armel and how she assisted him in dealing with his mentally ill son when the mental health system failed to respond appropriately. Despite a history of bipolar disorder and two hospitalizations, Fairfax Hospital had refused to admit Early's son until he posed posed "an 'imminent danger' to himself or others." But when he got to that point, the only option the system had was to try to lock him up in prison. Armel intervened to ensure that Early's son got treatment, not prison.

But that intervention by a caring police officer is the exception, not the rule, according to Early, who has writting a book on his experience called Crazy: A Father's Search Through America's Mental Health Madness

Police officers such as Detective Armel -- not doctors and therapists -- are now on the front lines when it comes to dealing with those who have mental disorders. Our mental health system is so deeply flawed that it is extremely difficult for people who are ill to get help. Instead they are being arrested for crimes they commit while they are psychotic. This is why jails and prisons have become our new asylums.

The federal Bureau of Justice Statistics has found that 300,000 inmates in jails and prisons take medications for severe mental illnesses such as bipolar disorder and schizophrenia. An additional 500,000 are on probation. Some 700,000 pass through the criminal court system each year. The largest mental facility in America is not a hospital; it is the Los Angeles County jail.

Data from the nonprofit Treatment Advocacy Center confirm this week's grisly headline. People with mental illnesses kill law enforcement officers at a rate 5.5 times greater than the rest of the population. People with severe disorders are also killed by police in justifiable homicides at a rate nearly four times higher than others.

The result of this breakdown in our ability to treat those who suffer from mental illness is not just a tragedy for them and their families, but for our society as well -- particularly for those members of our society who take on this nation's toughest and most dangerous jobs of providing us with security and providing assistance for people most in need of help -- in a system that refuses to provide the support that they need.

As Early wrote of his friend,

A good police officer, loving wife and mother of two children is dead. Her murder was preventable. Her killer should have gotten treatment. Their deaths should serve as a wake-up call. How many more police officers will be murdered; how many young men and women with untreated mental disorders must die, before we reform a disgraceful mental health system that fails to treat the sick and protect the innocent?

Related Articles

• Epilogue on the Death of Erlinda Ursua, December 22, 2004
• Workplace Violence in Health Care on the Rise, April 26, 2004
• Who really killed Dr. Erlinda Ursua? December 2, 2003
• Doctor Killed by Mental Patient, November 23, 2003
  

Yellow signs and red tape : New York's Workplace Violence Prevention Program?

Almost 14 years ago I received news that four AFSCME members, Phyllis Caslin, Florence A. Pike, DeniseVan Amburg and Nancy J. Wheeler, child welfare workers in the Schuyler County (NY) Department of Social Services, had been shot to death in their office by a man unhappy about being forced to make child support payments. Miller was able to walk into an unlocked back entrance, and climbed the stairs to their office.

The four women and their killer died on Thursday morning, when 50-year-old John T. Miller walked into the Schuyler County offices with a 9-millimeter handgun and shot one after the other, pausing once to tell a woman working in a nearby office that she could leave. Afterward, he calmly told deputies that he had "hurt everyone I came here to hurt." Then he held the gun to his right temple and pulled the trigger.

But that wasn't the first time that poor building security put workers at risk:

Marc Yerton remembers the day more than 20 years ago when a couple walked into the Chenango County Office Building and took a group of workers hostage in a day-long siege.

"I was here in the early 1980s when two people entered the building with guns and Molotov cocktails and took 22 people hostage,” said Yerton, a probation supervisor and 26-year employee.

Since that time, we've seen significant advancements made in an effort to protect employees from workplace violence. In 1997, federal OSHA issued guidelines to assist health care and social service workers to prevent workplace violence. Among the measures in the guidelines is one that recommends "Lock all unused doors to limit access, in accordance with local fire codes."

But according to an article in The Work Force, a publication of the Civil Service Employees Association of New York, AFSCME Local 1000 (no link), things haven't changed that much, at least in Chanango County:

The takeover didn’t result in any increased building security. “Nothing happened after that,” he said. “The county didn’t change its policies at all.”
CSEA Chenango County Local President Jerry Sayles, a county Highway Department employee, said the building has at least six unlocked, unguarded entrances.

The only sign of security at these entrances is literally a yellow sign on the doors noting that weapons are prohibited in the building. Other than a metal detector and deputy in the family court area, Sayles said, “it’s pretty much wide open.”

Sayles said the union has tried to get the county to increase security at the building and other county facilities, but county officials have been unwilling to act.

“In our labor–management meetings, we’ve asked for increased security, but they’ve been unwilling to do more,” Sayles said. “Our fear is that somebody could walk in with a weapon and not be stopped or even slowed down. Somebody could be hurt or killed.”

***

Yerton said people regularly joke about his office’s only security measure — a piece of red tape on the floor that probationers and other visitors to his office are supposed to stay behind. He said the signs on the building’s outside doors that prohibit weapons are equally ineffective.

“It’s a joke, the same as our red tape,” he said. “It’s the only measure we have — a piece of tape on the floor. We take care of each other — that’s the only real security we have.”

New York public employee have waited long enough to feel safe. CSEA, the New York Public Employee Federation and other public employees unions in New York are running a Secure Worksites Now! campaign that is supporting the Worksite Security Act (S.6441; A.9691) in the New York State Legislature. The law would require public employers with more than 20 employees to assess risk and develop a plan of action to prevent potential workplace violence. The bill would also establish a complaint procedure for workers to call attention to the potential for violence. CSEA trained 700 safety and health activists at the end of last month at the union's statewide Safety and Health Conference in Lake Placid at the end of the month. PEF is running regular trainings for its members as well.

Last week NY public employees rallied in front of the state capitol in support of the legislation. Last year, NY Governor George Pataki vetoed similar legislation that had been overwhelmingly approved by both houses of the legislature, citing "technical flaws."

CSEA and PEF held a press conference earlier this week where members who had been victims of workplace violence spoke of being attacked -- and of not being taken seriously afterwards:

"I was attacked by a patient while working as a registered nurse at Mohawk Valley Psychiatric Center," said PEF member Jill Dangler. "He broke facial bones including my jaw. I lost teeth, yet when I tried to file charges at the Utica Police Department, I was told that I knew of the risks when I took my job."

The campaign notes that although many people think workplace violence is random, unpredictable and therefore unpreventable, there are a number of common factors that increase a worker's risk of violence. These include:

• low staffing levels
• working alone
• working late at night or early in the morning
• working with money or prescription drugs
• long waits for services by customers, clients or patients; and/or lack of available services
• employees who work in homes or in the community.

CSEA Central Region President Jim Moore says that neither workers, nor the public should put up with the lack of security any more.

In this day and age, we live in a ‘post’ world – post-Schuyler County, post-Oklahoma City and post-September 11, which all serve as poignant reminders of what happens when security concerns are ignored. Chenango County can’t afford to continue their small-town ‘it won’t happen here’ mentality. That’s just what they thought in Watkins Glen, until four workers were killed. We all have a responsibility to honor their legacy and make sure that our workers and the public are better protected by getting a statewide standard enacted into law and preventively strengthening security measures.